How can we have an impact on mental health citywide? How can individual treatment methods be translated into policy? What does mental health look like through a public health lens? These were the questions raised during an On the Table discussion hosted by UICDR titled “Creating a Mental Health Resilience Plan for Chicago,” part of the series of conversations held on May 10 in conjunction with the Chicago Community Trust and the Kennedy Forum.
On the Table is an annual forum designed to elevate civic conversation, foster new relationships and create a unifying experience across the region. Thousands of Chicago-area residents gather in small groups to share a meal and discuss the challenges and opportunities the city is confronting. Over 55,000 people all over Chicago joined in this year’s discussions, with 270 of these conversations focused on mental health thanks to the Kennedy Forum’s participation. This is the second year that UICDR has been involved.
UICDR convened speakers from urban planning, public health, psychology, psychiatry, and early childhood education for this timely discussion. Only a couple weeks earlier, on May 2, Chicago announced its first Chief Resilience Officer, Aaron Koch.
The Rockefeller Foundation launched a 100 Resilient Cities initiative as part of a global plan to help cities become more resilient. Recognizing that “crisis is the new normal,” the Foundation rolled out a plan worldwide to address social and structural issues alike, issues of inequality, health, and the environment. The citywide resilience plan identifies what makes each city vulnerable and what can be done to strengthen it. In Chicago, an aging infrastructure, crime and violence prevention, and flooding were highlighted as priority areas of focus.
This On the Table discussion centered on recognizing the role mental health plays in these conversations. Mental health is implicit to human resilience. Resilience is the ability to bounce back or recover from an event. It is an important trait for the individual, as well as for the city of Chicago. And, mental health is part of the physical, social, and economic challenges of the 21st century. This conversation was an opportunity to make mental health an explicit part of the conversation.
These areas may be more closely connected than they first appear. As Dr. Charlie Hoch, Professor in the Department of Urban Planning & Policy put it: “The vocabulary of resilience in reference to urban planning and housing is very different to that of mental health, but there are strong linkages to be made.” Hoch studies spatial planning focusing on issues of homelessness and affordable/supportive housing.
“What I understand the city of Chicago wants to do is that they want to find ways to address both everyday stresses and extraordinary events: floods, tornados, or terrorist events,” explains Dr. Stevan Weine, an expert on extremism and disaster response with UICDR, who spoke at the event and has worked with Los Angeles, CA on developing their city-wide resilience plan.
Weine notes: “People, clinicians, sometimes have a misunderstanding of what the role of psychiatry and mental health is in a disaster or resilience. They think that it is just applying their clinical skills directly to treating patients. From a public health point of view how do you get out a certain amount of information or strategies that we can teach people through the media, through schools, through primary care to kind of get people some level of assistance that they can use on their own. A lot of our job becomes not directly treating people, but more education. So, education through the media or education through leaders in other institutions, like in schools, like in primary care clinics, like in faith-based institutions.”
Putting this framework into practice on the resilience end of the spectrum is Dr. Marc Atkins, Director of the Institute for Juvenile Research, who has spent the past two decades developing models for children’s mental health that leverage natural settings.
“We can’t just think of mental health as something that happens in clinics or hospitals. Mental health happens everywhere. By introducing opportunities for positive intervention into places where children already feel comfortable—home, schools, playgrounds, even on public broadcasting—we can have more success creating strategies that work.” Atkins argues.
He and his team currently operate a school-based program with 16 Chicago Public School serving more than 900 children and families, an afterschool recreation program with several park districts, a home visitation program for first time moms, and a partnership with the local public broadcasting station that infuses mental health content into short television spots. These touch points, which draw on a public health framework, provide an opportunity to foster resilience in the institutions where children are already involved.
Much of the literature for this work has been conducted internationally, where a lack of mental health professionals and resources is outpaced by need, but demands in the United States are quickly catching up. An estimated 14.8 million U.S. adults are affected by depression costing approximately $80 million annually due to lost productivity and health care with a shortage of mental health professionals.
“We need to increase the mental health workforce by training up,” says Dr. Pauline Maki, Director of the Women’s Mental Health Research, where she focuses on cognition and sex differences.
For Atkins, increasing the mental health workforce involves training paraprofessionals to provide support via home visits, in the classroom, or through the park district. From training teachers to use classroom-based interventions for disruptive students to deescalating aggressive behavior on the playground before it becomes violent, Atkins’ team has refined a public health approach that uses resources inherent in natural community settings to achieve mental health aims alongside social, emotional, recreational and educational goals.
Maki in turn trained OBGYN providers—physicians, nurses, midwives, attendees, residents—on using the PhQ9, a validated tool for screening depression among pregnant and postpartum women from low-income Chicago neighborhoods. Many of the women in the project were not receiving routine medical care prior to their pregnancy, let alone mental health care, but their routine check-ups provided a window of opportunity for the research team to address those barriers. In a six-week trial involving 25 women, the project decreased symptoms of depression, and was a marked success. Participants were better able to manage their mood and stress, and take on the responsibilities of motherhood.
Innovative strategies for leveraging the natural settings, institutions, and systems where people live, work, learn, and play, while expanding the mental health workforce to include paraprofessionals, teachers, coaches, and medical staff is the future of mental health. These interventions represent ways to meet the growing mental health needs of Chicago in an efficient, effective way.